Monday 26 March 2018

Delay in Payment to Empanelled Hospitals

Delay in Payment to Empanelled Hospitals

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA
UNSTARRED QUESTION NO: 4758
ANSWERED ON: 23.03.2018
Delay in Payment to Empanelled Hospitals
SHRI RAJIV PRATAP RUDY
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:
(a) whether there is a delay in the payment to empanelled hospitals under Government sponsored health programmes such as Central Government Health Scheme (CGHS) and Rashtriya Swasthya Bima Yojana (RSBY);
(b) if so, the details thereof and the reasons therefor;
(c) whether CGHS and RSBY has been effective in reducing the burden of out of pocket spending of poor households, if so, the details thereof; and
(d) the total number of beneficiaries and total funds allocated under CGHS and RSBY over the last four years, State/UT wise including Bihar?
ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)
(a) & (b): Under CGHS there is some delay in payment to empanelled hospitals. Following are the reasons for delay in settlement of hospital bills under CGHS:-
i. Resource constraints particularly in the last quarter of Financial Year.
ii. Need for consultation with Specialists in some cases.
iii. Time taken in scrutinizing of Hospital bills.
Under RSBY, Insurance Companies make payment, as due and admissible, to the empanelled hospitals as per their claim. Details are not maintained at Central level.
(c): Under CGHS, the beneficiaries, who are primarily Central Government Employees and Pensioners, are provided health facilities including OPD, medicines, reimbursement of expenditure incurred on hospitalization etc. and they do not have to incur out of pocket expenditure. They have to bear additional expenditure only if they opt for specific brand of implants costing more than CGHS rates.
Under RSBY, claims amounting to Rs. 5012.17 Crore have been settled since 2011-12 to 2016-17, which may be construed as a reduction in out of pocket expenditure for the beneficiaries under RSBY, who have availed the hospitalization benefits.
(d): There are 32,53,219 number of CGHS beneficiaries as on 13.03.2018.
The total funds allocated under CGHS over the last four years is as under:-
YEAR
Funds Allocated (Rupees in Crores)
2013-14
1772.75
2014-15
1734.02
2015-16
1872.29
2016-17
2026.91
Under RSBY no funds are allocated to States. Funds as central share of premium are released on receipt of proposals from State Governments. The State-wise list of beneficiaries under RSBY over the last four years including Bihar is at Annexure.
Annexure:-
RSBY Scheme: Statewise Status for last four years
S.No.
State
No. of Families Enrolled under RSBY
Year
2013-14
2014-15
2015-16
2016-17
1
Andhra Pradesh
2184
*
*
*
2
Assam
1416919
1421104
1421104
1421104
3
Bihar
6102774
818531
6899144
7028409
4
Chandigarh
5854
7865
*
*
5
Chhattisgarh
1962689
2141822
3442749
4146227
6
Gujarat
1900903
1876307
1876628
2691497
7
Haryana
463226
437850
437850
*
8
Himachal Pradesh
341818
481699
480588
480588

9
Jammu and
Kashmir

4988

*

*
*
10
Jharkhand
1923138
1714552
1682894
*
11
Karnataka
29417
6050439
6731881
6206620
12
Kerala
2747029
2018764
2021572
2060802
13
Madhya Pradesh
608748
608748
*
*
14
Maharashtra
234252
*
*
*
15
Manipur
68140
70383
70925
70925
16
Meghalaya
108321
65840
256138
256138
17
Mizoram
145842
152983
152983
194886
18
Nagaland
151806
128184
*
255314
19
Orissa
4238040
4307538
4462959
4462959
20
Pondicherry
9486
6467
*
*
21
Punjab
236764
232352
232352
*
22
Rajasthan
2511663
2692626
2769097
*
23
Tripura
505327
505327
492022
481331
24
Uttar Pradesh
5541225
285435
285229
*
25
Uttarakhand
285435
3839765
1464242
285229
26
West Bengal
5748689
6063390
6150716
6290446

Grand Total
37294677
35927971
41331073
36332475
* States not implementing RSBY during the period
Source : LokSabha

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